Rosacea is a chronic red facial rash that is poorly understood. It usually affects those aged 30-60 with fair skin, blue eyes and Celtic origin, but can occur in other ethnic groups.

Features include general redness, flushing, flaking, broken blood vessels often on and around the nose, red spots and sometimes pustules. It is often confused with acne, but with rosacea there are no blackheads or deep cysts and generally the red spots are dome-shaped rather than pointed.

The cause of Rosacea is unknown. It appears to be inseparably linked to sun damage, causing collagen in and around blood vessels to deteriorate. Temperature changes also trigger flushing. Many of my patients have Rosacea and part of the reason may be the harsh climate in Canada. Eventually the broken blood vessels leak inflammatory substances that cause the redness and, after many years, even thickening of the skin on the nose (Rhinophyma).

Although Rosacea is not related to acne, bacterial build-up must play a role, as can be deduced from the successful treatment of tetracycline orally and other antibiotics topically. Another theory is that a mite called Demodex Folliculorum may be involved in some cases. Rosacea may also be aggravated by facial creams and oils and especially by topical steroids. Alcohol, hot drinks, and spicy foods are also triggers. (This list is too long to include.)

While conventional treatments have always been aimed at the “symptoms”, (antibiotics, anti-inflammatories i.e. topical steroids, and laser), they are destined to fail unless the underlying causes are addressed. Principles of treatment for underlying causes should include repair of sun damage to epidermis and dermis, restoration of peri-vascular collagen and elastin, and reduction of the inflammation. There is no quick fix and patients often despair before giving treatment adequate time to be effective. The course of the condition is predictable and “prevention is better than cure.”

Dr. Setterfield’s topic in the next issue of TheCordovan will be “Advanced Skin Analysis”.